Kathryne DeWitt

NOTE -MyNexus was purchased in 2021 by Anthem BC/BS who later changed to Elevance Health. Carelon Medical Business Management is a division of Elevance Health.

Carelon SDOH(social determinants of health) and STARS(Medicare rating system).

*Responsible for coordinating with outside home health agencies, then later in house nursing staff, to obtain information on Anthem members with chronic health conditions in need of additional assistance.

*Running daily, weekly and monthly reports and tracking by region and area detailing members needs and follow up details.

*Coordinating with nursing staff and management to obtain and define relevant data.

*Adding and updating member referrals in the Carelon database.

*Answering calls and SMS texts from members and forwarding to appropriate nursing staff.

*Recognizing Healthcare emergencies via telephone and timely response by management .

* Ensuring both SDOH and STARS referrals completed in a timely manner.

* Able to quickly calm and/or diffuse complaints, or refer to Management.

* Demonstrated respect, friendliness and willingness to help wherever needed.

Responsible for daily coordination and placement of approved members of multiple clients/companies with home health agencies to provide care.

* Contacted doctor's offices when needed, to obtain current orders and patient clinical information.

* Entered referrals for care in database

* Fielded phone calls, answered queries and received requests from patients, family members, physician offices and home health agencies.

* Maintained up-to-date knowledge of MyNexus network home health agencies to effectively gain member acceptance.

* Documented all initial and ongoing member and home health agency contact.

*Routinely anticipated/identified potential issues and reported to manager.

* Assured that all physicians requesting home health for an eligible home member are vetted and added to the MyNexus system.

* Confirmed members requesting home health meet all current requirements per Medicare, and coordinated with Clinical Utilization Management staff.

* Kept patients advised of staffing process and resulting placement.

* Used discretion and independent judgment in handling patient or physician complaints. Documented and sent to appropriate staff.

• Provide superior customer service and act as patient advocate by scheduling travel services and support for dialysis patients worldwide
• Act as liaison between patients and clinics, Admissions Department, and Treatment Options Program (T.O.P.'s)
• Primary contact for general dialysis information and referrals of prospective new patients
• Ensure all intake data for customer service and patient travel requests is collected, completed and communicated per FMCNA policies and procedures, adhering to the UltraCare Superior Customer Service standards from intake to resolution on every call
• Utilize the appropriate call tracking and patient travel applications to ensure appropriate documentation of customer interactions, transactions, and travel requests
• Maintain and update inquiries, complaints and issues
• Work closely with Admissions and Billing Groups as needed to request and obtain insurance verification in a timely manner
• Coordinate and follow-up with pertinent staff and management to effectively respond to issues and inquiries, ensuring that the need or request is addressed and resolved appropriately in order to satisfy the patient's travel request
• Work closely with the Marketing Department to promote new clinics and services nationwide

• Responsible for initiating all referrals to hospice and palliative care services; screening and directing public inquiries for services via phone and in person
• Establishing rapport and providing excellent client service to referral sources, i.e., physician's offices, clinics and hospitals
• Operating and maintaining data on dedicated MISYS computer system; maintaining tracking logs and data
• Working with Marketing and Development Dept to improve client satisfaction and development of new advertising materials
• Training new personnel and serving on in-house, ongoing committee to analyze and develop new departmental procedures and policy

• Responsible for providing high quality business travel services to clients in a timely fashion, as well as being knowledgeable with the many products and services available to clients through American Express
• Maintained and increased client base; provided management and accounting support; researched and solved customer service issues; ongoing training and updating of computer technology